| NPI | 1093232431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9317606) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9317606) |
| Enumeration Date | 2017-08-26 |
| Last Update Date | 2018-05-07 |